Provider Demographics
NPI:1891226494
Name:CALDERON GALVEZ, GISELLE DE LA CARIDAD (BCBA)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:DE LA CARIDAD
Last Name:CALDERON GALVEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14272 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5813
Mailing Address - Country:US
Mailing Address - Phone:786-306-7525
Mailing Address - Fax:
Practice Address - Street 1:6235 KENDALE LAKES CIR APT C244
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1958
Practice Address - Country:US
Practice Address - Phone:786-306-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-48070106S00000X
FL1-21-50880103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020387600Medicaid
RBT-18-48070OtherBEHAVIOR ANALYST CERTIFICATION BOARD